Healthcare Provider Details

I. General information

NPI: 1396337440
Provider Name (Legal Business Name): ZACHARY DEWAYNE MURDAUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N I AVE
CROWDER OK
74430
US

IV. Provider business mailing address

PO BOX 506
CROWDER OK
74430-0506
US

V. Phone/Fax

Practice location:
  • Phone: 918-429-9170
  • Fax:
Mailing address:
  • Phone: 918-429-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: